Entrepreneur Rx_Rachel Mertensmeyer: Audio automatically transcribed by Sonix

Entrepreneur Rx_Rachel Mertensmeyer: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.

John Shufeldt:
Hello everybody, and welcome to another edition of Entrepreneur Rx, where we help healthcare professionals own their future.

John Shufeldt:
Hey everybody! Welcome to another episode of Entrepreneur Rx. I am really pleased to have Rachel Mertensmeyer on this, Rachel and I, had the opportunity to work together with her for gosh, probably a year now, and her very cool company called Rivia Health, and Rachel, I'm excited to do this with you.

Rachel Mertensmeyer:
Thank you, it's great to be here. Thanks for having me.

John Shufeldt:
I think there's a lot to learn. So Rachel is, you know, they always say bet on the rider, not on the horse, and although I think you have a good horse, we are, we at Xcellerant are betting on you. So that's going to be some subject matter knowledge to impart to people.

Rachel Mertensmeyer:
Thank you so much, I really appreciate that.

John Shufeldt:
All right, so let's back up. Now, as I recall, you do not have a, I mean, you are very entrepreneurial but don't have a, you have a communication background, right?

Rachel Mertensmeyer:
That's right, so I actually got my degree in communication studies at a liberal arts school. So I didn't go to school for business per se, but I did have, I started out my career really starting distribution for a wine company and kind of jumped into business right out of school with my first job, and I've been in product lead, product development, leadership roles, brand management roles, go to market strategy with Fortune 100 for about ten years before I started this company. So I don't have a formal degree, but I got a lot of diverse experience before I quit my corporate job to start the company.

John Shufeldt:
Well, so you actually have a formal degree, which is not, it's not a formal healthcare degree, but it's a communications degree, right?

Rachel Mertensmeyer:
Yes, that's right.

John Shufeldt:
All right, so you did say one word in there, which I have a lot of interest in, and that word was wine. Now, as I recall also, the wine you were distributing or working on, it was; was it in China?

Rachel Mertensmeyer:
Yes, that's right.

John Shufeldt:
That's a, so I've heard China is a pretty big wine-consuming nation.

Rachel Mertensmeyer:
Absolutely.

John Shufeldt:
No discrimination, but so what's the wine story? Like, how did that happen?

Rachel Mertensmeyer:
Yeah, so I actually was a violinist in college and my violin scholarship was sponsored by a couple called the Addams Family, and they have six wineries on the right bank of Bordeaux and three in California, and when I was graduating, they knew that I was really interested in working in China, and they needed someone they could trust to establish distribution for their chateaus and wineries in China because the market was blowing up. And this is when our economy was tanking, so they needed to shift the volume, essentially, and they hired me right out of college to go to Shanghai and establish an office there for them and then manage import contracts for their wine across East Asia. So that was my first job out of college. So I felt really fortunate to get that opportunity and it really kind of set my career in motion.

John Shufeldt:
Okay, so back up. Did you even speak Chinese when you went over there?

Rachel Mertensmeyer:
Not really. I had been trying to learn on my own with one of those like software language learning programs, but I really hadn't had any formal training because the school that I went to didn't offer Mandarin yet. And so I actually started the momentum to get Mandarin classes at my school, which they now have, in an East Asian studies program, which I kicked off before I left my senior year, but no, I didn't speak Mandarin yet. So I really only knew like right, left, go, this, that, hello, thank you. Those were, that was pretty much the extent of my language capability.

John Shufeldt:
Okay, so did you know anything about wine?

Rachel Mertensmeyer:
Not really, I was pretty much a geek and was dry until I turned 21, and I was like 21 when I got this job, so I had just started drinking. So I actually went to Barnes & Noble and I bought like five huge books about wine and just like, read them all, and I got good training from the company. They let me shadow some of the other wine import managers across the world. So I went to New York, shadowed their leader in New York, went to Europe, shadowed the leaders there, California. So I got some learning from them, but it was a two-week crash course. So, yeah, I was pretty much starting from scratch across the board.

John Shufeldt:
That is so cool. What are the three wineries they own in California?

Rachel Mertensmeyer:
So they own White Cottage Ranch in Napa and then they own Adler Fell's Winery, which is a winery that does a lot of corporate white labeling, so that's like mass production, and then they also own Roblar Winery in Santa Ynez, and then in Bordeaux, they own six chateaus on the right bank. Or they did, I actually sold, I sold one of their chateaus to one of my customers in Hong Kong, so I guess technically they have five now, but.

John Shufeldt:
Wow, that is one cool job out of college.

Rachel Mertensmeyer:
It was, it was, I got, I was very fortunate and I've always felt like I got a really lucky break having that be my first job, especially because I graduated during the recession, I graduated in '09. And so I, before I got that break, I had actually applied to probably 26 Starbucks and a lot of different retail jobs just to get a job, you know, to start making money, and I had been denied all of those jobs. And then I had also tried to take the standard corporate route and like applying to tons of consulting firms and things like that for like a quote-unquote real job, and the job market was just really dried up. So at that time, they were only offering me internships. You know, in the US, if you were graduating from college in '08 or '09, you could work for free to get a quote-unquote real job, but that was pretty much it. So I felt really fortunate that I was able to get a job with great experience right out of college.

John Shufeldt:
Basically, it trained you for raising venture capital, is what I'm hearing you say, a lot of no's before you get the yes.

Rachel Mertensmeyer:
Yes, definitely.

John Shufeldt:
That's classic. Okay, so how long were you in Shanghai for doing this wine job?

Rachel Mertensmeyer:
So I was with the wine company for two years and actually in that, in those two years I got all of their available wine distribution locked up in five-year contracts. So I kind of put myself out of a job in a way because they're luxury wines, so they don't have endless volume to sell, and so they wanted me to come back to the States at that point and continue working for them in the United States, but I didn't really feel like I was ready to leave China. So what I did is I started like kind of networking with my friends in China, and I was able to find a job with BBDO. So I joined BBDO as an account manager there and worked with them. They're one of the big three advertising agencies and I was working with their office in Shanghai helping brands like Tory Burch and Lafayette 148 New York enter the China market. So that was my second job, and then after that, I worked for WPP. So one of the other advertising agencies there, and I worked on the Ford Motor Brand and helped them localize all of their global marketing campaigns and marketing digital assets for Asia Pacific across 12 markets. So altogether, I was in China for five years.

John Shufeldt:
Wow, okay, so two of the wine, three with the agency. And then what finally prompted you to come back?

Rachel Mertensmeyer:
So I had a fabulous mentor, Alok, who told me that if I stayed in China much longer, that I would start to be kind of pigeonholed as a China expert and that it would be very difficult to build a global career or a career back in the States. And so I took his advice and I actually, again, through networking, one of my friends who worked at Avon helped me get the job there. She let me know they had a position available and I worked at Avon in Global Brand Management after that in New York City. So really kind of moving from the agency side to the brand management side, taking a different perspective there, and then working at a global level versus a regional Asia-Pacific level. So that was exactly what I wanted and it was a great experience. I got a lot of experience working at Avon because there was a lot changing in their office at the time. They were actually shutting down and selling the North America business, so there was basically a lot of opportunity to step up and take leadership roles during that transitional period for them.

John Shufeldt:
That is very cool. Okay, so far I've heard other than ruining your liver, drinking wine, I've heard nothing as it relates to health or the human body. So how did that start?

Rachel Mertensmeyer:
That's true, so I actually worked at Unilever after Avon. I was at Unilever doing global brand management on skin cleansing for Dove Men, and then I moved to the North America hair care business for Dove, so that was the last role that I had. And while I was at Unilever, I had a really severe injury, and that injury resulted in 38 medical bills across 11 different healthcare providers and over $10,000 in medical debt.

John Shufeldt:
Was this like a violin injury?

Rachel Mertensmeyer:
No, no, it was actually a really crazy fluke injury where I was at a conference center and walking through those really large automated revolving doors and a wind burst hit the door and the door malfunctioned and it went into fire safety mode, and I was still in the center console of the door, and so basically the door collapsed and I was in the center panel.

John Shufeldt:
You got crushed by a revolving door.

Rachel Mertensmeyer:
Yeah, it's a crazy story. Then I ended up in the emergency room and had a head injury and a spine injury, so yeah, but that was my first real encounter with the healthcare industry.

John Shufeldt:
Wow, okay, so that is, yeah, that's off the charts crazy, actually. So you have all these injuries and you have all these bills. So what aha moment did you have?

Rachel Mertensmeyer:
That aha moment was actually after my recovery. So it was about six months after my recovery when I could actually have the capacity to sit down and sort through all of these bills that I was getting. And I was sitting at my kitchen table and I had three stacks in front of me, paid, unpaid, and question mark, and I had an Excel spreadsheet I had to create to try to figure out what bills were duplicates, what had already been paid, what was still pending with insurance and onward, and so I realized that for patients, they really have so many barriers to payment, and it's not that patients aren't like willing to pay their bills, it's that we make it very difficult for them because we're not applying modern technology to the problem. So there were no modern communication technology applied and no, there was no modern payment technology applied. And as someone who was always leading digital production within the roles that I held in Fortune 100 companies, I was just shocked that we weren't applying modern tools to that experience. And it really impacts patients really significantly because, one, you're already dealing with a very emotional experience as someone who is a patient and, you know, patients that I interviewed when I started this business who were cancer patients actually told me that their second fear next to death was dealing with medical bills, which it sounds trite in a way, but it's actually really real for them, and it's terrible that in America we're putting people through that experience. And a lot of it is just the headache of trying to manage all of their bills and logging into different portals, dealing with paper billing, dealing with practices that only accept a check that you have to put in the mail or waiting on the phone to pay for 45 minutes only to find out you've called the wrong number. So it's really just a challenging process, and then the last thing I'll say is that 80% of healthcare providers offer payment plans for patients that are credit risk-free, zero interest, but most patients aren't aware of that. So 45% of patients use credit cards to finance their healthcare payments. And so that was another key area that stood out to me that we need to improve, apart from just the convenience and making it easier for patients to understand.

John Shufeldt:
You know, it's interesting, over the weekend, I, there was a friend of a friend who was here from Canada and they needed a parish in pieces. We have a large amount of ... fluid in their abdomen, but they're from Canada. And so they started calling around for a week trying to find somebody to do this for them, they couldn't. So while ... in the emergency department, but that's not the place ... and it's very expensive to do. So I said, okay, well, look, I'll come in and do it for you, I'll just meet you there. And so don't worry about that part, but this, well, how much is the hospital going to cost? And I said, I don't have a clue. So they spent four or five days trying to figure out how much the ED bills me, and they still kind of figure it out when even when they were there, they said, we just want to pay here. I don't think they're going to accept your money here because I don't know how much to pay.

Rachel Mertensmeyer:
Right, yeah, it's a huge challenge.

John Shufeldt:
And so I said the same thing you just said is, you know, I'm sure they have a payment plan because for them it's cash out of pocket and it's not going to be I mean, I'll be cheap, but the hospital won't be cheap.

Rachel Mertensmeyer:
Right.

John Shufeldt:
So, yeah, that's interesting. So then what happened? You have all these bills there in three piles and you have, you're like, This is ridiculous.

Rachel Mertensmeyer:
Yeah, so I thought to myself, Oh, I'm sure there's an app for that, right? I use TurboTax, Credit Karma, Venmo. So I went on the App Store and I looked for a tool to help me, I couldn't find one that was specific for healthcare bills, and I went online and looked for one, couldn't find anything, and that's when I got the idea to create a mobile app that would be like a TurboTax for medical bills. And as you know, that was how we started out, the business was building a direct-to-consumer mobile app. However, since then we have pivoted and now we're B2B SaaS and it's a very different product, but still with the heart of making it easier for patients to pay and get visibility to their payment plans.

John Shufeldt:
And then how easy, and I know the answer, but for folks listening, how easy is it for someone to, if they're on Athena, for example, because I know that's probably the easiest, for them to use your system for their patients?

Rachel Mertensmeyer:
So from a customer perspective, they can be, like a healthcare practice is our customer, and a healthcare practice can go live in two weeks or less with us because we have an existing integration with Athena. So really it's as simple as them signing an online form and filling out a configuration worksheet, so it's like 30 minutes of their time, and then we do all of the work and we have them live in two weeks. So it's a very simple process for the customer.

John Shufeldt:
And then for some groups, you take maybe a year, like in the emergency department, for example.

Rachel Mertensmeyer:
Yeah, exactly, that's a great point. If we don't have an existing integration, it can take longer, yes.

John Shufeldt:
Interesting, so from the patient perspective, then what are they seeing? So they go into the doctor's office or the surgery center, they have a procedure, and then what happens?

Rachel Mertensmeyer:
Yeah, so the patient, with Rivia Health, this journey can start either before their appointment. So, for example, they might receive a text message that says you have an upcoming appointment with Dr. Rachel on this date and you have a co-pay balance available to pay for that appointment, click here to pay your balance. So it can start with the co-pay before the appointment or a pre-appointment payment plan or a pre-service payment plan. Or we can message you, if you have an outstanding balance after your appointment, as well, you might receive a text or an email that says you have an outstanding balance that is now 30 days late, for example, but you qualify for a payment plan, click here to pay now. And then once the patient clicks on a link from one of those messages, they are going to be brought to a web app, so there's no login required, there's no app to download, they don't have to create an account or remember a password. So all they have to do to view their bill is enter their birth date, we send them a text verification code, which we already have their phone number on file, we're pulling that from the practice management system, and then from there, they can view all of their outstanding balances, they can see billing details and even line items of the bill so they really understand what they're paying for or why they owe this bill. And then if there are payment plans that they qualify for, they'll be notified and can self-enroll in different payment plan options as well or pay their bill in full, and from there we write all of the data back to the practice management system automatically. So for the healthcare practice organization, it's a completely automated process that's happening in the background and we just get them paid essentially and send them an email every month saying, This is how much we contributed to your revenue this month.

John Shufeldt:
Right in the background, that is really interesting and much easier. I mean, I've had some medical things in the last couple of years and, you know, I'm in the system. I mean, I understand the game, and it's still a very difficult to navigate. So you're right. I mean, if you're not, if you don't know somebody or don't have that perspective, you are lost, so that's very cool. What's been the biggest learning for you? Because it doesn't sound, I mean, you were in large companies that, I think the Shanghai experience with the winery is very entrepreneurial because you were thrown into a strange land, speaking of strange language, and all of a sudden you're it, and I don't, it was wine, they're ubiquitous. I mean, where, was wine a well-known commodity there?

Rachel Mertensmeyer:
It was a well-known commodity for sure, but I would say that the audience and the consumers, they were really looking for more education on wine. So because it was a more nation to experience in China than it might be in Europe, for example. So they were very hungry to learn and really interested, and so it was fun because I got to tailor all of our marketing materials and messaging for that market and help to position the wine in a way that would be interesting to them, and a lot of that was centered around education.

John Shufeldt:
How did you do that not being from that culture? I mean, because I mean, me trying to come up with an ad campaign for a culture that was foreign to me. I wouldn't even know where to start. How did you do that? That's remarkable.

Rachel Mertensmeyer:
Yeah, so it was a lot of listening because I didn't have a big budget, so I couldn't run a focus group. I did that later for Lafayette 148 New York, when I was helping them position their brand for China, we had more formal focus group processes. But for the wine business, I really just listened. I had a translator that I worked with and I was also learning Mandarin on my own. So I would interview and just talk to consumers every day, right? I was outpouring wine, doing wine tastings, talking to consumers, understanding their perspective about wine, why they valued it, why they were buying it, you know, is it a gift or is this going to be used at a party or a banquet? Like how are they consuming it? And just through discovery, through conversations, I was able to position the brand and really kind of figure out what was resonating with them.

John Shufeldt:
Interesting, so that was a very entrepreneurial experience and that gave you some training for this one. But what has been your, what's been the hardest thing for you with Rivia?

Rachel Mertensmeyer:
The hardest challenge?

John Shufeldt:
Right.

Rachel Mertensmeyer:
Let's see, it's hard to pick one. I would say.

John Shufeldt:
Pick a lot of them because I think people don't always understand that it is a, I mean, it's hard, it's hard. So hit me.

Rachel Mertensmeyer:
I would say, you know, finding product market fit is really, really difficult, that's probably number one. And as you know, we did have to pivot to find product market fit, and it was a very difficult journey where we started out building a mobile app for consumers, and what's really interesting with that is that we did all of the quote-unquote right things to do, right? We created a clickable prototype, we got user feedback. I interviewed 100 patients before we even started writing down what features we would build. So we thought that we were doing a lot of the right things, but what was missing was, you know, are they willing to pay for this, right? And how are you going to monetize this on a large enough scale to create a multi-million dollar business or a billion-dollar business, right? How are you going to grow a venture-backed startup? And what we learned is that patients don't expect to pay for their healthcare, right? So in order to monetize an app like that, then you really have to get financial services products to finance and become the revenue. So we interviewed with Visa Healthcare and HSA platforms that were interested in selling their services in a marketplace format within the app, and the interesting thing there is that you need like over a million patients before they'll talk to you. So they're interested, they validated the concept, they validated they would want to pay us to have visibility there or a partnership there, but they would need a million patients on the platform before they would start entering us into their pipeline. So that was like the first major kind of wall that we hit where we built a product that patients loved, that they were adopting, and it was growing organically, people were just downloading it from the App Store without any ads being against it because it's a really, it was a really great product and people enjoyed using it. And we got picked up on ABC 15, got some visibility there, but at the end of the day, we couldn't really monetize it just with the direct-to-consumer model. And that's when we started pivoting, looking at what would an on-ramp be and we started looking at B2B2C at areas and we explored the employer, the payer, the provider, all of these different channels, landed on the provider, and then went on a journey of launching a B2B2C platform during COVID. So that was another area that was very difficult, was leading a startup and a startup team during a pandemic, so that was like another major challenge that we faced. And then even the B2B2C model didn't work, right? So then we had to refine that further and really figure out what our new customer, the healthcare practice, what did they want, what was product market fit for them? Because that's very different from what a patient wants and what the feature set that the patient is looking for. So we essentially had to go through the entire discovery process and rebuild the entire software platform and relaunch it as B2B SaaS. So that whole journey of product market fit during a pandemic, I would say, kind of encapsulates at a high level the most difficult challenge that we faced.

John Shufeldt:
Yeah, I know, I had the good fortune to be able to watch some of it, and you are resilient as hell. And along the way, you had some challenges with investors as well, and I know you don't want to probably speak specifically about it, but what was your takeaway from that? Because I think all of us had some takeaways from it as well. But what was your takeaway from it?

Rachel Mertensmeyer:
Yeah, I think my takeaway is that entrepreneurs should always do due diligence on their investors just as much as investors do due diligence on them and the company because you are choosing a partner when you accept investment and it's a partner that's going to be with you for a really long time and is going to, you're really putting your business in the investor's hands in a lot of ways, and it's important that there's trust and also an understanding around making sure that your values are aligned, making sure that your philosophies of how you are going to grow the business, are aligned, etc., and just have a lot of conversations and understand who's investing in you before moving forward, and that would be kind of my key takeaway and learning. And then secondly, I would add that entrepreneurs should be very careful not to accept an investment that they don't need in the early days of their business so, and also be careful about over-dilution. So especially for female founders, since female founders tend to get, and women of color even more so, tend to get lower valuations than white male founders, it's really important that you try to get to some level of revenue, I would say, before accepting investment so that you can really benchmark your valuation in a healthy way and really know what you should, what your company is worth before you're accepting investment. So that would be the advice that I would give to new founders. Interview and do due diligence on your investors, and don't accept money if you don't have to. Run as lean as you can for as long as you can and get to revenue before accepting capital if possible.

John Shufeldt:
I'm not sure that diligence would have helped you through that challenge you had. I don't know, I don't know if they had a track record of doing that, but I don't know if diligence would have helped you, and maybe you would have picked it up had you asked people and interviewed other people, but I got the sense that was a little bit out of the left field. The other one is on valuation, I think and I agree with all the ones that you said, and particularly wait and wait and wait as long as you possibly can to bring in venture capital, because the longer you wait, the better off you're going to be with less dilution, so you're dead on. But I also think that you suffered from a pretty decent valuation out of the gate and then you had to, because of the economy and because of the, a couple of fits and starts with adjusting your product market fit had accepted down round which is, I've been there and it's painful, but it's reality, and it's reality for everybody in the last in this economic cycle. What, if you had to do it again, what would you have done differently, if anything?

Rachel Mertensmeyer:
Gosh, that's a hard question. You mean specifically in this last year?

John Shufeldt:
Yeah, because you'll be here again. I mean, maybe not with Rivia, but for your next venture, after Rivia becomes a unicorn and you crush it, for your next venture, what would you do differently?

Rachel Mertensmeyer:
So I would say, for the next venture, you know, it would likely be still, B2B SaaS in healthcare, right? I would probably start another company in a similar space because I'm very familiar with it now, and there's so many interesting problems to solve in this industry. So with that specific industry example, I would find a customer first. So that would be, my first step would be to identify a customer and then really kind of develop like the product concept, but then say, if I build this, will you buy it, right? Can I get a commitment from you and will you give me input on what I'm building? And then that way you have revenue as soon as that product is, you know, is ready, and is ready to go live, and that's really the strategy that I would take next time. And then, you know, that customer can even be a strategic investor as well and kind of help in the early days. I know there are risks to that model as well because you can also become beholden to the strategic investor/customer and really lose control of driving product development so that it has product-market fit on a broader level, so I know there are some risks there, but I think that derisks a lot around product-market fit, funding, financing the business, and the development of the product and all of that. So that would be one key difference, and I might even try to find multiple customers, right, to kind of derisk that area of being beholden to one group. And then the other thing I would do differently is I would really try to avoid raising capital, like we talked about earlier, until we really need to scale, and then hopefully at that point, we already have enough evidence of product market fit and revenue that we're getting a really healthy valuation, and then we're starting the company out in a really healthy way in terms of cap table balance, and I would also just have as much capital efficiency as possible and be super disciplined from that standpoint. Not that we haven't been, but, you know, I've just learned through surviving COVID and a market crash, like how important it is to preserve capital and just make sure that every dollar is going in the direction of revenue generation.

John Shufeldt:
Perfect, all right, those are good ones, and I agree with all of them. I mean, I think you summed it up perfectly. Okay, last question for you. When I first met you and now even delving deeper into your story, you know, the one word that jumps out at me is resilience. I mean, you are resilient as hell. And I think now I know a little bit more about you, if you're going to be a concert violinist, you have to be resilient. I don't know about the violin, but I think you'd have to be resilient. Was this something that you were born with? Did you develop it over time? Where did it come from and how important was it for you?

Rachel Mertensmeyer:
It's a good question. I mean, I think it must have been something that I developed over time. I would say, you know, just being transparent, I was never one of those students who just pick things up naturally, right? So I always had to work really hard in school and in just my learning, I was dyslexic and still am, so, you know, that really impacted my learning and all of that. So I think at a very young age, I had to work really hard to get good grades, and I always valued, I was really ambitious and always wanted to get A's, so I think just the determination that I had in school helped build up some of that resilience and then, I would say that, yeah, with music and violin, again, I was never a natural violinist, you know. I worked really hard at it, and I started, quote-unquote, late in life for classical musicians. I started playing violin at age 12, so I had to work really hard to catch up and be able to be in the Phoenix Symphony Guild and play in college orchestra through high school, and so I'm sure those contributed to it, but it's difficult to say. You know, I have lived a pretty privileged life in a lot of ways. I have really supportive parents and I was able to go to college and have most of that, you know, either paid for through scholarships or my family support. So I don't want to like, make up a story of hardship, right, but I will say just learning through school was difficult for me, and I did end up going to college early, or I went to community college for high school, so it all paid off and I was able to kind of advance quickly through school, but it wasn't easy. So that was probably a key part of it. I was like, for example, in college when most kids were like out partying or experiencing their college life or surfing or whatever, I went to school in California, you could find me in the library or in a coffee shop studying. And people always knew, like, Rachel is going to be in the library and studying, and that's because school just never came easily, so I always had to spend more hours than everyone else to get the same grade, so.

John Shufeldt:
So that's resilience, that's perfect. Well, Rachel, this has been great, and congratulations. Like I said, I know Rivia well, and you've done a phenomenal job with your challenges and the pivots you've taken. You literally are the definition of an entrepreneur, so keep up the great work. I'm looking for great things.

Rachel Mertensmeyer:
Thank you so much, thanks for having me this morning, John.

John Shufeldt:
My pleasure. Well, folks, another great episode of Entrepreneur Rx. We'll have the transcript and all the connections to Rachel and Rivia Healthcare, and until next time, have a wonderful week. Thank you all.

John Shufeldt:
Thanks for listening to another great edition of Entrepreneur Rx. To find out how to start a business and help secure your future, go to JohnShufeldtMD.com. Thanks for listening.

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